Skoog Primary Periosteoplasty versus Secondary Alveolar Bone Grafting in Unilateral Cleft Lip and Alveolus: Long-Term Effects on Alveolar Bone Formation and Maxillary Growth
Skoog Primary Periosteoplasty versus Secondary Alveolar Bone Grafting in Unilateral Cleft Lip and Alveolus: Long-Term Effects on Alveolar Bone Formation and Maxillary Growth
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DOI：
10.1097/prs.0000000000002910
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发表时间：
2017-01-01
影响因子：
3.6
通讯作者：
Nowinski, Daniel J.
中科院分区：
文献类型：
--
作者：
Jabbari, Fatima;Hakelius, Malin M.;Nowinski, Daniel J.
背景：涉及牙槽突裂的治疗方法有两种：一种是唇部修复时的一期骨膜成形术，另一种是混合牙期的二期牙槽骨移植。大多数研究小组倾向于二期牙槽骨移植，因为其成功率很高，而且有人担心一期骨膜成形术可能会干扰上颌骨的生长。然而，初级骨膜成形术可能会消除未来植骨的需要，在一些中心仍在进行。很少有研究比较这两种策略的长期效果。方法：对57例出生时单侧唇裂和牙槽裂的患者进行回顾性研究。所有患者均采用Skoog方法进行一期唇部修复，28例患者在修复唇部时接受了一期骨膜成形术，其余29例患者在混合牙列时接受了二期牙槽骨移植。在10岁和16岁时获得的咬合X光片分析了牙槽骨高度。结果：28例接受一期骨膜成形术的患者中有17例需要二次植骨，且一期骨膜成形术组16岁时的骨高度较低(p<；0.0001)。在初次骨膜成形术组中，从5岁到10岁的上颌前突有更明显的减少(p<；0.03)。结论：一期骨膜成形术对上颌骨的长期生长无明显抑制作用，但作为牙槽突裂的一种修复方法效果不佳。
Background: Clefts involving the alveolus are treated using one of two strategies: primary periosteoplasty at the time of lip repair or secondary alveolar bone grafting at mixed dentition. Most teams favor secondary alveolar bone grafting because of its high success rate, and concerns have been raised that primary periosteoplasty may interfere with maxillary growth. However, primary periosteoplasty may obviate the need for future bone grafting and is still practiced in some centers. Few studies compare the long-term outcomes of these two strategies.Methods: Fifty-seven consecutive patients born with unilateral cleft lip and alveolus were studied retrospectively. All patients underwent primary lip repair using Skoog's method; 28 patients underwent primary periosteoplasty at the time of lip repair and the remaining 29 underwent secondary alveolar bone grafting at mixed dentition. Occlusal radiographs obtained at ages 10 and 16 years were analyzed for alveolar bone height. Cephalometric analysis assessed growth at ages 5, 10, and 18 years.Results: Seventeen of 28 patients treated using primary periosteoplasty required later secondary bone grafting, and the bone height at age 16 years was lower in the primary periosteoplasty group (p < 0.0001). There was a more pronounced decrease in maxillary protrusion from ages 5 to 10 years in the primary periosteoplasty group (p < 0.03). However, at age 18 there was no significant difference in maxillary growth between the two groups.Conclusion: Primary periosteoplasty did not seem to inhibit long-term maxillary growth but was ineffective as a method of reconstructing the alveolar cleft.